NEONATAL TECHNOLOGY, PERINATAL SURVIVAL, SOCIAL-CONSEQUENCES, AND THEPERINATAL PARADOX

Exogenous surfactant therapy for premature infants with respiratory di stress syndrome has had a significant impact on infant mortality and o n some complications of prematurity. Yet the total number of low-birth weight infants has not declined, resulting in a high-risk population w ho would require surfactant therapy and long-term child care. Survivin g low-birthweight infants (despite surfactant therapy) remain at risk for the consequences of premature birth, such as neurosensory impairme nt, cerebral palsy, and chronic lung disease. In addition, because of the close association between poverty and low birthweight, surviving p remature infants are at increased risk for the new morbidities such as violence, homelessness, child abuse and neglect, and addictive drug u se. A goal should be to reduce the risk of being born with a low birth weight, rather than having to treat the consequences of premature gest ation. Despite the marvelous advances that permit us to treat respirat ory distress syndrome, the continuing high low-birthweight rate places a significant strain on our health care system. The goal should be re directed to identifying large population-based efforts to reduce the n umber of low-birthweight infants.